Resistance exercise training improves mucociliary clearance in subjects with COPD: A randomized clinical trial.

INTRODUCTION: Elastic tubing was recently investigated as an alternative to the conventional resistance training (RT) in chronic obstructive pulmonary disease (COPD). The effects of RT on the mucociliary system have not yet been reported in the literature. OBJECTIVE: The aim of this study was to evaluate the effects of two RT programs on mucociliary clearance in subjects with COPD. METHODS: Twentyeight subjects with COPD were randomly allocated by strata, according to individual strength of lower limbs, to defined groups: conventional resistance training (GCT) or resistance training using elastic tubing (GET). Nineteen subjects (GET: n=9; GCT: n=10) completed the study and were included in the analysis. The measurement of vital signs (blood pressure, heart rate and respiratory rate), lung function (spirometry) and the primary outcome mucociliary clearance analysis (saccharin transit time test (STT)) were performed before and after the 12 weeks of RT. RESULTS: In relation to the mucociliary transportability analysis, no differences were observed between the baseline evaluations of the training groups (p=0.05). There was a significant reduction in the STT values in both training groups, GET (10.64±5.06 to 6.01±4.91) and GCT (12.07±5.10 to 7.36±2.54) with p=0.03. However, no differences between groups were observed on the magnitude of SST changes after interventions (GET: -43.51%; GCT: -38.94%; p=0.97). CONCLUSION: The present study demonstrated that both RT with elastic tubing and conventional training with weights promoted similar gains in the mucociliary transportability of subjects with COPD.

Effects of exposure to biomass burning on pulmonary inflammatory markers and pulmonary function in individuals with COPD.

INTRODUCTION: Pulmonary rehabilitation (PR) has many benefits for individuals with COPD. However, it is not clear whether PR could prevent the hazards of air pollution exposure. This study aimed to analyze the effects of biomass burning exposure on pulmonary inflammatory markers and pulmonary function in individuals with COPD, participants and non-participants of PR. METHODS: 35 subjects were divided into three groups: individuals with COPD who received PR (G1, n=15), those who did not (G2, n=10), and a control group composed of healthy individuals without COPD (CG, n=10). Measurements of lung function and concentrations of IL-6, IL-10, and TNF-α in exhaled breath condensate samples were collected. The assessment and concentrations of particulate matter (PM10), nitrogen dioxide (NO2), ozone (O3), temperature (T), and relative air humidity (RAH) were recorded in biomass burning and non-burning periods. RESULTS: There was a significant increase in the concentrations of air pollutants in the biomass burning period. In this period, an increase in IL-6 (G1p=0.041, G2 p=.012), and a reduction in the FEV1/FVC ratio (G1p=0.021, G2 p=.007) were observed in individuals with COPD. In G1, the increase in IL-6 concentrations correlated positively with O3 (r=0.693; p=.006), and negatively with RAH (r=-0.773; p=.003) in the burning period. CONCLUSIONS: Individuals with COPD exposed to biomass burning demonstrated increased pulmonary inflammation and a reduction in the FEV1/FVC ratio, regardless of their engagement in PR.

Is walking in daily life a moderate intensity activity in patients with chronic obstructive pulmonary disease?

BACKGROUND: So far there are no studies investigating whether the time spent walking in daily life by patients with COPD corresponds to an activity of at least moderate intensity according to the recommendations of the American College of Sports Medicine (ACSM). AIM: To quantify in patients with COPD the time spent/day in physical activity of at least moderate intensity according to the ACSM (TPA>moderate); and to compare their TPA>moderate with the total time spent walking/day in daily life (TW). DESIGN: Cross-sectional study. SETTING: Patients entering in a pulmonary rehabilitation program at a University Hospital in Brazil. POPULATION: Seventy-three patients with COPD (FEV1 40±15% pred; 65±9 years). METHODS: TW and TPA>moderate were respectively assessed with the DynaPort and SenseWear activity monitors for 12 hours/day during 2 days. RESULTS: There was significant difference between TW and TPA>moderate (53 [36-80] versus 12 [3-33] minutes/day, respectively; P<0.0001). Although 84% of patients reached more than 30 minutes/day of TW, only 29% reached more than 30 minutes/day of TPA>moderate. TPA>moderate correlated modestly with TW (r= 0.52; P<0.0001). CONCLUSION: The majority of patients with moderate-very severe COPD walk more than 30 minutes/day; however this does not mean that they are physically active, since less than 1/4 of their time spent walking can be considered as moderate-intensity activity. CLINICAL REHABILITATION IMPACT: Moderate-intensity physical activity in patients with COPD is more reduced than previously known. There is a clear need to increase their daily physical activity and lead a higher proportion of this population to comply with the minimum recommendations.

Mucociliary clearance and its relation with the level of physical activity in daily life in healthy smokers and nonsmokers.

OBJECTIVES: To investigate the relationship between mucociliary transport and physical activity in daily life (PADL) in smokers and nonsmokers. METHODS: Fifty-two current smokers were submitted to assessment of mucociliary transport (Sacharin Transit Time, STT), carbon monoxide levels in the exhaled air, lung function and smoking history. In addition, subjects kept a pedometer worn at the waist for six days in order to determine their level of PADL (steps/day). The tests were also performed on 30 matched healthy nonsmokers who served as control group. RESULTS: Light smokers (≤15 cigarettes/day) had a STT of 9 (7-11) min (median [confidence interval]), which was similar to nonsmokers (8 [8-11]min; p=0.8). Both moderate (16-25 cigarettes/day) and heavy (>25 cigarettes/day) smokers had significantly higher STT (13 [11-17] min and 13 [10-21] min, respectively) than nonsmokers and light smokers (p<0.05 for all). There was no difference in the number of steps/day between any of the groups (p>0.05 for all). In the general group of smokers, STT was not significantly correlated with PADL, pack/years index, years of smoking or age (r<-0.23; p>0.09 for all). There was significant negative correlation between STT and PADL only in light smokers (r=-0.55; p=0.02) and nonsmokers (r=-0.42; p=0.02), but not in moderate and heavy smokers. CONCLUSION: In light smokers and non-smokers, better mucociliary function is associated to higher daily physical activity level, as opposed to the decreased mucociliary function observed in smokers, i.e., those with moderate and heavy cigarette consumption.

Drenagem postural x tapotagem x tecnica de expiracao forcada: analise da transportabilidade do muco bronquico / Drainage postural x tapotagem x forced expiratory technique

E comum na fisioterapia respiratoria a utilizacao das manobras de higiene bronquica, no entanto, ainda nao esta bem claro o melhor protocolo de atendimento, visto que os efeitos isolados de cada manobra necessitam ser mais explorados, inclusive com metodos de analise de transportabilidade do muco bronquico. Este estudo analisou amostras de muco bronquico expectorado por 12 bronquiectasicos submetidos a drenagem postural isolada e associada a tapotagem e a tecnica de expiracao forcada. Para analisar a transportabilidade foi realizada a mensuracao do angulo de adesao, do deslocamento do muco na maquina da tosse e da velocidade relativa de transporte no palato de ra, alem do peso umido e da relacao peso seco/peso umido do muco. Houve forte tendencia de remocao de maior quantidade de secrecao apos drenagem postural isolada e associada a tapotagem, alem da tendencia de remocao de secrecao com menor teor liquido apos duas sessoes (50 minutos) de drenagem postural associada a tapotagem. O angulo de adesao do muco removido apos 80 minutos da conduta CONT foi menor (p<0,05) e, proximo da normalidade, de facil remocao. Neste caso, considerando que as demais manobras nao contribuem para a piora das qualidades fisico-quimicas do muco, e que os tempos iniciais das condutas anao apresentaram diferncas estatisticas, o muco expectorado por essas manobras apresentou angulo distante da normalidade, sugerindo que em todos os tempos das condutas estudads o muco expectorado apresentou pior perfil reologico, isto e, de dificil remocao, e somente pela aplicacao das mesmas edsse muco pode ser removido